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Background: Supporting the sleep health of surrogate decision-makers of patients in the intensive care unit is a research priority. However, few studies have approached sleep health as a multidimensional construct, instead focusing on 1 or 2 dimensions in isolation. Objective: To holistically examine the sleep health (satisfaction, timing, efficiency, duration) of surrogate decision-makers of critically ill patients. Methods: This secondary analysis involved surrogate decision-makers of incapacitated intensive care unit patients at a tertiary medical center in northeastern Ohio (n = 19). Sleep-health data were captured by means of a subjective scale (satisfaction) and objectively (timing, efficiency, duration) by means of a wrist-worn accelerometer (Actiwatch Spectrum Plus; Philips Respironics). Upon enrollment, participants completed the satisfaction scale and wore the Actiwatch Spectrum Plus for 3 consecutive days. Descriptive statistics of the study variables were evaluated. Results: A minority (15%) of the sample reported poor sleep satisfaction. Sleep timing variables were comparable to those found in other adult studies. Participants averaged approximately 6 hours of sleep per day with an average sleep efficiency of 83.7%. Conclusions: Despite adequate satisfaction scores, intensive care unit surrogate decision-makers' sleep duration is inadequate and sleep efficiency is suboptimal. Sleep-health interventions may be needed in this at-risk population. Future research should consider the impact of surrogate decision-maker sleep health on their capacity to serve in the surrogate decision-maker role. [ABSTRACT FROM AUTHOR]

A review of the article "Factors Associated With Parent-Perceived Miscommunication in the Pediatric Intensive Care Unit," which appeared in the periodical's November 2024 issue, is presented.

Background: Family intensive care unit (ICU) syndrome, a comorbid response to another person's stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue. Objectives: This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU. Methods: The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline. Results: The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7. Conclusions: Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care. [ABSTRACT FROM AUTHOR]

A discussion guide for nurse-researcher Anna E. Krupp's article on a support tool for early mobility of critical ill patients is presented.

A review of the article "Noninvasive Ventilation for Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-10" by Alexander A. Botsch and colleagues which appeared in the July 2024 issue of the "American Journal of Critical Care" is presented.

The article comments on Amanda C. Moale's study which examined the perspectives of family caregivers, health care providers and administrators about family caregiving following critical illness. Topics discussed include perspectives on post-intensive care syndrome (PICS), the impact of social determinants of health (SDOH) on caregivers' experiences, and the need for health care systems to transition toward more inclusive care models.

The article offers a discussion guide for the study "Hyporexemia Induced by Oxygen Therapy in Nonsurgical Critically Ill Patients." Topics of the study include association of oxygen-therapy-induced hyperoxemia with hospital mortality in nonsurgical critically ill patients, factors related to oxygen-therapy-induced hyperoxemia upon hospital admission and its association with the need for mechanical ventilation, vasopressors and renal replacement therapy.

The article presents a discussion guide for the article "Fasting Versus a Heart-Healthy Diet Before Cardiac Catheterization: A Randomized Controlled Trial" by Cari Woods. Topics include the fasting required for patients scheduled for coronary artery catheterization, study results on heart-healthy diet group, and advice given by Woods for future researchers.

Background: The Hospital Anxiety and Depression Scale (HADS) is commonly used clinically and scientifically among surrogate decision makers for critically ill patients. The validity of the HADS has been scrutinized, but its use among surrogate decision makers has not been examined. Objective: To examine the structural validity of the HADS. Methods: This study was a secondary analysis of data obtained from a 3-arm randomized controlled trial of a decision support intervention. Participants were recruited from 6 intensive care units at a tertiary medical center in Northeast Ohio. Participants were adult surrogate decision makers for critically ill, cognitively impaired adults who were not expected to be discharged from the intensive care unit within the subsequent 48 hours. The fit of 2-factor, 3-factor, and bifactor structures of the HADS was tested with confirmatory factor analysis. Results: The bifactor structure, possessing a general psychological distress factor and anxiety and depression group factors, showed a superior fit and met a priori thresholds for acceptable model fit. The general psychological distress factor accounted for more than 75% of the common variance in the HADS items. Conclusion: Confirmatory factor analysis provided evidence supporting a bifactor structure of the HADS. In this sample, the instrument validly measures psychological distress rather than distinct symptoms of anxiety and depression. Replication of these results is encouraged, and use of alternative measures is recommended when measuring distinct symptoms of anxiety and depression among surrogate decision makers for critically ill patients. [ABSTRACT FROM AUTHOR]

The article presents a discussion guide for the research "Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices" by Kristin A Tuozzo. It summarizes the effects of evidence-based bed rest practice change including groin complications and hospitalization, as well as the importance of a multidisciplinary approach to implementing changes. It considers the clinical implications of the evidence-based implementation of bed rest reduction after cardiac catheterization.

The article discusses a study which recruited 107 pediatric intensive care unit (ICU) PICU nurses to explore the factors that influence the nurses' decision-making when assessing and managing pain in a child requiring neuromuscular blockade (NMB). Cited are a wide variety of methods used by the nurses to assess and manage pain at the bedside, the odds of a nurse intervening for pain management, and the clinical implications of the study.

A discussion guide for the article "Written Communication, Visitation Policies, and Awareness of Meidcal Issues Among Intensive Care Unit Families" by Jared Greenberg is presented. It suggests written communication strategies as a promising method to enhance a surrogate decision maker's understanding of the clinical condition of the patient. Intensive care unit problems identified among the patients include respiratory failure, hypotension/shock, encephalopathy and renal failure.

A discussion guide for the article "The Mindful Ethical Practice and Resilience Academy: Sustainability of Impact" is presented. It states the objective of the study to evaluate the effects of Mindful Ethical Practice and Resilience Academy (MEPRA) on promoting ethical confidence, moral competence, resilience, work engagement, mental health, mindful attentiveness and burnout among nurses. Also noted is the significance of building evidence base around the impact of multidimensional programs.

The author discusses the article "Receptive Music Therapy for Patients Receiving Mechanical Ventilation in the Intensive Care Unit," published within the issue. Topics include effects of stressors faced by patients receiving mechanical ventilation (MV), promising means of alleviating stress responses among MV patients, and the influence of live music therapy (LMT) on physiological stress of critically ill adults receiving MV.

The article discusses the results of a study on the factors that may contribute to the development of delirium in patients confined in intensive care units (ICU). Topics mentioned include a description of predicting models to determine a patient's risk of developing ICU delirium, the exclusion of the presence of mechanical ventilation due to its possible impact on patients, and the use of multivariable regression and interpreted receiver operating curve characteristics.

The article provides a discussion guide for the study "How Patients and Families Describe Major Medical Treatments: They Are No Longer Living, Just Existing." It presents a definition of life support and offers an overview of the scope of the study to clarify the concept of life support to maximize the provision of value-concordant care in the intensive care unit (ICU). Three categories of discourse related to major medical treatments (MMT).

The article discusses research led by Daniela Fernanda dos Santos Alves on the implementation of interprofessional rounding checklists within the pediatric intensive care unit (PICU). The study describes a five-step process to develop and validate an interprofessional rounding checklist (R-PICniC) for a 20-bed PICU. Research findings indicate the association of the quality of interprofessional communication in the PICU practice environment to positive appraisals of overall safety climate.

A review of the article "Epidemiology of Organ Failure Before and During COVID-19 Pandemic Surge Conditions" that was published in the July 2022 issue is presented.

The article discuses the results of a study on the use of sedation for patients in the intensive care unit. Topics mentioned include the circumstances that critically ill patients can receive heavy sedation, the relation of sedation-agitation scale (SAS) and Richmond agitation-sedation scale (RASS) scores to light sedation occurrence, and the accuracy of SAS and RASS in determining the light sedation occurrence.

The article provides instructions and tips on how to effectively assess the article about the measurement of acuity and pediatric critical care nursing workload using the intensive care unit complexity assessment and monitoring to ensure optimal outcomes (ICU CAMEO) acuity tool. The measurement results are used to establish standardized guidelines for pediatric ICU (PICU) staffing models.

The article offers information on the hospital-acquired pressure injuries risk assessment model developed by Phillip Kim, chief resident of general surgery at New York Presbyterian-Columbia University Medical Center, and investigators. Limitations in risk assessment and prevention methods for HAPI prevention and treatment is cited. The Braden Scale as a risk assessment tool depends on the subjective judgment of a clinician. Variables considered as risk factors for HAPI are cited.

A review of the article "Delivering Cognitive Behaviorial Therapy for Post-Intensive Care Syndrome-Family via a Mobile Health App" in an issue is presented.

A review of the article "Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support" in a 2021 issue is presented.

A review of the article "Racial/Ethnic Differences in Stress, Coping, and Distress Among Mothers With a Child in the ICU" in a 2021 issue is presented.

The article discusses a report on the gap between the intensive care unit (ICU) and the acute medical care unit. Topics mentioned include the potential benefit of implementing early ICU aftercare interventions, the lack of evidence to guide the care of ICU survivors, and difficulties with managing ICU survivors in the hospital setting.

A review of the article "Pulmonary Microbiome of Patients Receiving Mechanical Ventilation: Changes Over Time" in a 2021 issue is presented.

A review of the article "Nurses' Perceptions of Workload Burden in Pediatric Critical Care" that is published within the issue is presented.

A review of the article "Migration of Feeding Tubes Assessed by Using an Elevtromagnetic Device: A Cohort Study" is presented.

A review of the article "Grief Reactions of Potential Organ Donors' Bereaved Relatives: An Observational Study," which appeared in a September 2020 issue of the journal, is presented.

A review of the Evidence-Based Review (EBR) article "Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study" which appeared in the July 2020 issue of the "American Journal of Critical Care (AJCC)" is presented.

The article reviews and critiques the study "Nursing Turbulence in Critical Care: Relationships With Nursing Workload and Patient Safety" that was published within the issue. Topics covered include the methods and design of the study, a preliminary measure for turbulence, nursing activities not represented by workload, developed by the study investigators, and the impact of the development of preliminary turbulence measure for nursing practice and patient care.

The article comments on the evidence-based review (EBR) paper "Variation in the Management of Pain, Agitation, and Delirium in Intensive Care Units in British Columbia" by Peter M. Dodek and colleagues. Topics discussed include the negative outcomes of pain, agitation and delirium (PAD) among critically ill patients, the examination of PAD assessment tools, protocols/algorithms and management approaches, and opportunities to improve practices related to critical care.

The article discusses a study that examined the effect of an ethics intervention on a series of clinical outcomes for each admission among six intensive care units from three academic medical centers. Highlights include the three components of the intervention, post-study focus groups done to improve subsequent delivery of the intervention, and improvement in formal communication between family members and clinicians through the intervention.

The article discusses a study that examined the safety of biweekly chlorhexidine gluconate (CHG) baths in a sample of infants who were 36 to 48 weeks' post-menstrual age and had a central venous catheter. Highlights include measurement of blood levels of CHG at regular intervals for up to 12 weeks, routine skin assessments and safety checks conducted by bedside providers, and future animal studies on the impact of CHG on organ system development.